Health Coaching for Prediabetes in Primary Care

Ryan Sherman
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by Ryan Sherman

In the United States, primary care has historically treated patients using a “sick care” model, a system which waits for patients to become ill before they are treated.   However, the advent of the Affordable Care Act, gave rise to patient centered medical homes, which are designed to support a primary prevention model, a system which seeks to prevent the onset of disease.  In an effort to prevent the development of type two diabetes, many patient centered medical homes have instituted proactive HbA1c screening for patients at high risk for developing type two diabetes.

Unfortunately, even with preemptive testing, most patients with prediabetes do not receive proven interventions that prevent or slow the development of diabetes.  On occasion, patients will receive counseling from their primary care physician regarding the benefits of weight loss, physical activity and diet, but due to a lack of resources patient centered medical homes are not capable of delivering time intensive, evidence based interventions, such as the Diabetes Prevention Program.  Massachusetts General Hospital’s Ambulatory Practice of the Future (APF), a patient centered medical home, is no different, as it does not have the means to provide a comprehensive educational and behavioral lifestyle intervention, which call for frequent dietary counseling and supervised exercise sessions.  However, the APF does have the resources to provide health coaching.

As a Wellcoaches certified health coach, working at the APF I set out to explore the preliminary outcomes associated with behavioral health coaching for adults with prediabetes.  Through a retrospective chart review I found that patients with prediabetes who received an average of seven health coaching sessions, over a five month period:

– Lowered their HbA1c from 5.85% to 5.64%, over a two years.
– Sustained an average weight loss of 12 pounds, over a two years.
– Experienced a continued improvement in HbA1c and body weight after the active health coaching period concluded, suggesting the potential for a sustained effect of the intervention.
– Most commonly set goals associated with: Cardiovascular exercise (82%), Strength training (71%), Food Preparation (59%)

Due to the study’s limitations a direct correlation between the use of a health coaching model and a reduction in HbA1c cannot be drawn.  However, this retrospective study generated a need to further evaluate the effectiveness of a health coaching intervention, when delivered to patients with prediabetes, as it may provide a feasible and effective behavioral intervention that can be delivered within a patent centered medical home.  To read the full article, recently published in the American Journal of Lifestyle Medicine, please follow this link: Primary Care-Based Health Coaching for the Management of Prediabetes

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